Cavus Foot

What is cavus foot?

Children with cavus foot have arches that are much higher than usual. Often, their heels point inward and all of their toes are flexed.

They have trouble finding shoes that fit. The tops and middles of their feet become sore. They may have pain and develop thick calluses under the ball and at the outer edges of their feet.

Because their high arches make their ankles roll outward slightly, children with cavus foot may feel like their ankles are about to give out. Sometimes they sprain their ankles over and over again.

What causes cavus foot?

Children are rarely born with this problem. Instead, cavus foot usually develops slowly over the first 10 years of life.

In almost all cases, children develop cavus foot because they have a nerve or muscle disease. The disease makes some of the muscles weaker than others. These unbalanced muscles work unevenly, which causes the high arch and other signs of cavus foot.

An inherited disorder called Charcot-Marie-Tooth disease (CMT) is the most common cause of cavus foot. But there is a long list of disorders that may cause the problem. Children who have muscular dystrophy (MD) and spina bifida, for example, are more likely than others to develop cavus foot in both feet.

Cavus foot can affect only 1 foot, too. This is more common in children with injuries to the nerves in their legs or spinal cord or to the muscles in their legs. Other conditions that make it more likely a child will develop cavus foot are cerebral palsy and spinal cord tumor.

Why choose Seattle Children’s for cavus foot treatment?

The experts in our Foot and Ankle Deformities Program, which is part of Orthopedics and Sports Medicine, treat cavus foot.

  • The foot experts you need are here
    • Our Foot and Ankle Deformities team includes experienced pediatric , , and nurses who know how to evaluate and treat all types of foot and ankle conditions.
    • To restore or improve your child’s health, function and quality of life, we may use nonsurgical methods, like physical therapy or , which may help for a while. We have onsite orthotists and the largest team of physical therapists in the Pacific Northwest who specialize in the care of babies, children, teens and young adults.
    • Most children will need surgery at some point. We recommend surgery only when we believe it will give your child the best results. For those who need surgery, we have pediatric orthopedic surgeons with expanded fellowship training in foot and ankle conditions. 
  • Treatment designed for growing bodies
    • Infants, children and teens are still developing, so they may need different care than adults do, like treatment that takes their growth plates into account. At Seattle Children’s, your child’s team has special training in the physical, emotional and social needs of young people.
    • We understand your child’s body doesn’t stop at their foot and ankle. We see them as a whole person.  For example, in our Foot and Ankle Deformities Program, we look at not only your child’s feet and ankles but also their legs, spine, strength, movement and other features that might play a role in their condition, like nerve problems.
    • We have the largest group of board-certified pediatric radiologists in the Northwest. For imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images.  
  • Support for your whole family
    • Having a child with a foot or ankle condition can be stressful for the whole family. From the first visit to follow-up, our team will work to give your child seamless care and make your experience here as easy on you as we can.
    • Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s condition and treatment options. We support you in making choices that are right for your family.
    • Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Center and Guest Services are here to help. 
  • Research to improve care
    • Seattle Children’s is active in the Pediatric Foot Research Group, an international group of researchers studying foot and ankle differences in children.  
    • Our growing research program is discovering better ways to diagnose and care for these conditions. It’s funded in part by the Lynn Taylor Staheli Endowed Chair in Pediatric Orthopedics.
    • Outcomes research helps us know which treatments get the best results. For example, we use tools to ask children about their function after surgery for limb deformities. Asking children about their experience is essential to improving their lives.
    • We take part in several registries (databases that collect information about patients who volunteer) so we can work with doctors around the country and the world to better understand orthopedic conditions, such as foot, leg, hand and arm differences.
    • Learn more about current orthopedics research at Seattle Children’s

What are the symptoms of cavus foot?

The most obvious symptom of cavus foot is a very high arch or arches in 1 or both feet. People with cavus foot may also have:

  • Calluses on the side, heel or balls of their feet
  • Bent toes (hammertoes)
  • Tightly flexed toes (claw toes)
  • Pain while walking or standing
  • Tendency to sprain ankles

How is cavus foot diagnosed?

First, we ask your child to stand while we examine their feet. Because cavus foot tends to run in families, we often ask to examine the feet of parents and other family members too. We also check:

  • The strength of your child’s legs, ankles, feet and toes since cavus foot often comes along with diseases that make muscles weak
  • Your child’s spine to make sure it is flexible and the right shape
  • Your child’s reflexes in the legs and belly (abdomen)

We will ask whether your child has had any problems controlling bowel movements or bladder. Finally, we will take X-rays of your child’s back and feet.

If we find that your child has cavus foot, we will begin to look for the cause of the problem. At Seattle Children’s, our orthopedic doctors work closely with our neurologists to find the right answer.

  • Diagnostic tests

    Your child may need to have several tests to find the cause of cavus foot, including: 

    • Electromyogram and nerve conduction velocity (EMG/NCV) studies
    • Blood test for Charcot-Marie-Tooth disease (CMT)
    • MRI (magnetic resonance imaging) of the spine and brain

How is cavus foot treated?

Our orthopedic surgeons work closely with  to find the cause of your child’s cavus foot. Then we consult with specialists at Seattle Children’s to treat the cause. 

In some cases, as with Charcot-Marie-Tooth disease , there is no treatment for the nerve or muscle problem causing cavus foot. 

Once we address the underlying problem, if possible, we talk with you and find the best treatment for your child’s cavus foot. In most cases, the best treatment is surgery. 

In the very early stages of cavus foot, or with mild cases that are not getting worse, we may be able to use arch supports and shoe changes to help relieve problems until surgery becomes necessary. Physical therapy might also be helpful. 

Surgery for cavus foot

Surgery for cavus foot is complex. It often involves 2 operations done 2 weeks apart. In the first operation, the doctor cuts and releases the tightest of the soft tissues in the arch. Over the next 2 weeks, the rest of the tissues relax.

In the second operation, the doctor cuts and reshapes at least 1 bone using a  and moves  to new places on the foot to improve muscle balance. 

When we do surgery for cavus foot, our main concerns are to:

  • Correct the problems without joining together any joints (fusion)
  • Balance the muscles so that the problem is less likely to happen again 

After surgery, children often have physical therapy to help them return to their usual activities.

Contact Us

Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, a second opinion or more information.

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